Indispensability of pelvic and paraaortic lymphadenectomy in endometrial cancers.
Indispensability of pelvic and paraaortic lymphadenectomy in endometrial cancers.
复制标题
子宫内膜癌盆腔和主动脉旁淋巴结切除术是必不可少的。
作者：
Y. Yokoyama;H. Maruyama;Shigemi Sato;Yoshiharu Saito
本研究旨在分析子宫内膜癌腹膜后淋巴结转移与临床病理危险因素的关系，探讨腹膜后淋巴结转移与患者生存的关系。对1988年4月至1995年12月间63例子宫内膜癌患者同时行盆腔淋巴结(PLN)和腹主动脉旁淋巴结(PAN)清扫的病例进行了分析。Ia级1级和IV级疾病的患者被排除在本分析之外。第I期(FIGO，1988)患者中有10.0%(4/40)同时存在PLN和PAN转移。在14例PLN转移者中，8例(57.1%)同时存在PAN转移，而49例无PLN转移者中有4例(8.2%)同时存在PAN转移。PLN阳性的部位或数目与PAN转移无明显关系。多因素分析显示，恶性程度低、肌层侵犯深与PAN转移独立相关，血管间隙侵犯、宫颈侵犯与PLN转移独立相关。按分期分为I-II期和III期，各期RLN转移者的预后均明显差于无转移者。此外，PAN转移者的生存率明显低于单纯PLN转移者(分别为44.4%和80.0%，P<；0.05)。这些结果表明，即使在早期子宫内膜癌中，PLN和PAN转移也很常见，而RLN转移，特别是PAN转移，对患者的生存有严重影响。总之，在患者条件允许的情况下，对除Ia级1级和IV级外的所有子宫内膜癌患者，系统地同时进行盆腔和腹主动脉旁淋巴清扫是必要的，以提供预后信息，选择合适的术后治疗方法，并进行准确的FIGO分期。
The purposes of this study were to analyze the relationship between retroperitoneal lymph node (RLN) metastasis and clinical and pathologic risk factors in endometrial cancers, and to clarify the correlation between RLN metastasis and survival of patients with the disease. This analysis included 63 patients with endometrial cancer who underwent simultaneous pelvic lymph node (PLN) and paraaortic lymph node (PAN) dissection between April 1988 and December 1995. Patients with stage Ia grade 1 and stage IV disease were excluded from this analysis. Both PLN and PAN metastases were found in 10.0% (4/40) of patients with stage I (FIGO, 1988) disease. Of 14 cases with PLN metastases, 8 (57.1%) had PAN metastases simultaneously, whereas 4 (8.2%) of 49 cases without PLN metastases had PAN metastases. There was no significant relationship between the sites or numbers of positive PLN and PAN metastases. Multivariate analysis revealed that poor grade and deep myometrial invasion had an independent relationship with PAN metastases, whereas vascular space invasion and cervical invasion were independently associated with PLN metastases. When divided into the groups of stage I-II and stage III, the prognosis of patients with RLN metastases was significantly poorer than that of patients without RLN metastases in each stage. Furthermore, survival of patients with PAN metastases was significantly worse compared with that of patients with only PLN metastases (44.4 and 80.0%, respectively, P < 0.05). These results reveal that PLN and PAN metastases occur frequently even in early-stage endometrial cancer, and that RLN metastases, especially PAN metastases, have a serious impact on patient survival. In conclusion, systemically simultaneous pelvic and paraaortic lymphadenectomy is essential for all the patients with endometrial cancer except those with stage Ia grade 1 and stage IV to provide prognostic information and select suitable postoperative treatment as well as to perform accurate FIGO staging, provided the condition of the patient permits.